The Adolescent to Adult Patient-centered HIV Transition Study (ADAPT)

以患者为中心的青少年到成人艾滋病毒过渡研究 (ADAPT)

基本信息

批准号：
9206304
负责人：
Manhattan E Charurat
金额：
$ 28.17万
依托单位：
UNIVERSITY OF MARYLAND BALTIMORE
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-08-19 至 2021-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9206304
关键词：
19 year old Address Adolescence Adolescent Adult Advocate Affect Africa South of the Sahara African Appointment Area Caring Characteristics Child Childhood Clinic Clinical Cluster randomized trial Continuity of Patient Care Country Data Development Education Educational Intervention Ego Enrollment Ensure Epidemiology Equation Evaluation Faculty Focus Groups Funding Government HIV HIV Infections HIV-infected adolescents Health Health Personnel Health care facility Healthcare Systems Human Individual Infection Institutes Institution Intervention Lead Letters Life Maryland Measures Medical Modeling Nigeria Nigerian Outcome Outcome Measure Ownership Parents Participant Pathway interactions Patient-Focused Outcomes Patients Process Provider Psychosocial Factor Randomized Randomized Clinical Trials Research Resources Role Services Site Social Network Social Sciences Social support Structure Support Groups Support System System Time Universities Viral Load result Work adolescent patient aged arm base design effective intervention emerging adult expectation experience follow-up improved innovation insight low and middle-income countries medical schools medical specialties patient oriented pediatric human immunodeficiency virus peer primary outcome programs psychosocial public health relevance randomized trial response satisfaction secondary outcome tool virology

项目摘要

One of the distinct challenges faced by emerging adults with HIV is the transition of their care from their long- term pediatric HIV provider to treatment within an adult HIV program. While conceptually the transition from pediatric to adult care may seem straightforward, the reality is that the transition often is a very difficult process. The consequences of an unsuccessful transition can range from difficult to catastrophic. The Adolescent to Adult Patient-centered HIV Transition (ADAPT) Study is a randomized trial of innovative interventions targeting gaps in care that are major drivers of loss in the ART continuum of care cascade among adolescents and increasing missed opportunities to engage adolescents into care. The specific aims of ADAPT are: (a) to inform strategies for transition services in resource-limited settings; (b) to examine the developmental, clinical, and other factors that predict a successful transition; and (c) to gain fundamental insight on implementation barriers among African adolescents through the application of the ego-network defined social support that will inform targets for structured intervention. Our multi-PI team includes strong complementary expertise in pediatric and adolescent HIV care, epidemiology, and social science. ADAPT will be conducted in central, southern, and northern Nigeria at selected PEPFAR sites supported by the Institute of Human Virology, Nigeria. To address Aim 1 we will conduct six focus groups including: Adolescent patients, parents and health care providers. To address aim 2, we will conduct a cluster randomized clinical trial. The two interventions are based on prior evidence-informed engagement strategies: 1) educational interventions and 2) interventions that use a peer transition advocate who prepares the adolescent and their parents for transition. We will enroll 300 patients (150 patients in each arm). The sites will be randomized to an intervention. The primary outcome will be successful transition, keeping two follow-up appointments within a nine months period following transition. Secondary outcomes, as recommended by focus group participants will also be measured. To examine the potential role of social network components and characteristics of both egos and alters on primary outcomes, a Generalized Estimating Equation (GEE) approach will be used to explore the associations between primary outcomes and factors at the ego, alter, and network levels. The finding from this study will guide institution of best practices for transitioning adolescents in Nigeria and other countries lower and middle income countries with similar challenges and potential for high impact.

新出现的艾滋病毒感染者面临的独特挑战之一是他们的护理从长期护理过渡到长期护理。定期儿科艾滋病毒提供者在成人艾滋病毒计划中接受治疗。虽然从概念上讲是从儿科到成人护理看似简单，但现实是，过渡往往是非常困难的过程。转型不成功的后果可能是困难的，也可能是灾难性的。这以青少年患者为中心的艾滋病毒过渡 (ADAPT) 研究是一项创新性随机试验针对护理差距的干预措施是导致 ART 连续护理级联损失的主要驱动因素青少年并越来越多地错失让青少年接受护理的机会。具体目标 ADAPT 的目标是： (a) 为资源有限环境中的过渡服务战略提供信息； (b) 审查预测成功过渡的发育、临床和其他因素； (c) 获得基本的通过应用自我网络洞察非洲青少年的实施障碍明确的社会支持将为结构化干预的目标提供信息。我们的多 PI 团队包括强大的儿科和青少年艾滋病毒护理、流行病学和社会科学方面的补充专业知识。适应将在尼日利亚中部、南部和北部的 PEPFAR 研究所支持的选定地点进行人类病毒学，尼日利亚。为了实现目标 1，我们将开展六个焦点小组活动，包括：青少年患者、父母和医疗保健提供者。为了实现目标 2，我们将进行整群随机临床试验。这两项干预措施基于先前的循证参与策略：1）教育干预措施 2）使用同伴过渡倡导者进行干预，让青少年及其父母做好准备过渡。我们将招募 300 名患者（每组 150 名患者）。这些站点将被随机分配到干涉。主要成果将是成功过渡，并在一段时间内保留两次后续预约过渡后九个月的时间。次要结果，根据焦点小组参与者的建议也将被测量。研究社交网络组成部分的潜在作用以及两者的特征自我和对主要结果的改变，将使用广义估计方程（GEE）方法来探索主要结果与自我、改变和网络层面因素之间的关联。这这项研究的结果将指导尼日利亚和其他国家制定过渡青少年的最佳实践具有类似挑战和潜在高影响力的低收入和中等收入国家。